Stage II: Gingival grafting
After a 1-month waiting period post debonding of the braces, gingival grafting was carried out using the subepithelial CTG technique (Conective tissue grafting tunnel technique) in the mandibular anterior region (Figure 3). The connective tissue graft was acquired from the right maxillary in the area mesial to the premolars and the first maxillary molar. 2% Lignocaine hydrochloride with adrenaline was used for local anesthesia, and then the first incision was given parallel to the long axis of the palate. The thickness of the flap was kept sufficient to ensure no tearing of the tissues. Root planning was done on the lower incisors before placement of the graft.
The harvested graft was sutured over the exposed root surfaces. Pressure was applied over the graft for a few minutes, and a periodontal pack was placed for healing. The patient was recalled after 2 weeks, the sutures were removed, and the healing appeared normal (Figure 3b, 3c).